Acne sufferers should check out TCM remedies and pay attention to their lifestyles. Liu Zhihua reports.

Acne woes are more than just skin deep. In most cases, the skin disorder is caused by a mixture of factors, such as stress, hormonal irregularities, poor eating habits and unhealthy lifestyles, doctors warn. Li Ruohong, a 28-year-old Beijinger, has been seeking treatment for her acne for years. She had her first pimple attack about six years ago, when they developed on her forehead and around her lips while she was preparing for post-graduate school exams.

"I was under great pressure and often stayed up late," Li recalls.

Since then, the acne has alternately disappeared and flared up again whenever she doesn't get enough sleep or feels stressed.

"My classmates and colleagues used to tease me by saying they could tell if I had a good night's sleep from the acne on my face," Li says.

Acne includes pimples, deeper lumps and plugged pores, mostly on the face.

From Western medicine's perspective, acne results from an increase in androgens, or male sex hormones, which causes follicular glands to enlarge and produce increased sebum, explains Bai Yanping, vice-director of the dermatological department of China-Japan Friendship Hospital in Beijing.

The follicle may get blocked as sebum builds up, resulting in acne. The skin problem often occurs during adolescence but may also affect mature adults.

For adults, acne problems are mainly caused by unhealthy lifestyles, such as too much fast food, says Bai, who combines traditional Chinese medicine (TCM) with Western treatments. "We call the problem 'McDonald's face'."

According to TCM, acne is caused by "the imbalance of yin and yang energy in the body", says Li Minghui, a TCM doctor with Beijing-based Ciming Checkup Group.

Chinese medicine focuses mainly on balance. The yin (cool, calming side of the body) and the yang (hot, stimulating side of the body) energy need to maintain a balance to achieve good health. Once the balance is impaired by factors such as emotions, improper diet and overwork, the body will become ill.

For instance, if you sleep too little, the yin energy will decline beyond the normal range, Li Minghui explains.

When yin energy becomes inadequate, the yang will predominate. The excessive yang will transform into heat, accumulating in organs like the lungs, stomach, spleen, liver and heart.

These organs will function abnormally - usually becoming over-active - and acne will occur.

Acne caused by the various over-active organs is accompanied by different symptoms, Li Minghui says.

Li Ruohong sought TCM help after Western medicine failed to cure her acne.

"To treat acne, we must reduce internal heat in the organs. It is important to identify the targeted organs from the symptoms," Bai, with the China-Japan Friendship Hospital, says.

The treatment usually involves a customized prescription of herbal formulas and sometimes acupuncture.

Herbal medicines, with "cool" properties, such as honeysuckle and skullcaps, are used to reduce the excessive heat in the body, Li Minghui, of Ciming, says.

For average acne sufferers, the treatment will likely last for one week. As soon as the redundant heat in the body is dispelled, the skin problem will vanish, he adds.

"The situation has not been dealt with once and for all, but TCM does work better for me, because it helps improve my overall health," Li Ruohong says.

Chinese acne healing methods also emphasize a healthy diet.

Avoiding foods high in sugar and fat that may boost the yang energy and ultimately trigger acne, while eating foods like mung beans, bitter gourd and lotus seeds may prevent and help relieve acne, according to TCM doctor Li Minghui.

Also, Li suggests maintaining a good mood and avoiding stress.

Beijinger Chen Miao, 25, once had acne all over her cheeks, chin and around the mouth for about six months, which made her feel less confident socially.

"I started to get acne when my relationship with my boyfriend worsened. I was always in a bad mood and had too many negative thoughts," Chen says.

The doctor said she had a "heated" stomach and liver, and prescribed her herbal concoction to reduce the heat.

After two weeks, the acne started reducing.

"It was like a miracle, since I had tried so many anti-acne cosmetics and the problem just kept getting worse," Chen says.

Chen now tries her best not to be too anxious, no matter what happens in life.